Download High Fiber Diet - Medical Nutrition Therapy Manual

Medical Nutrition Therapy Diet: Diverticulitis (High Fiber)
Caitlin Gaynor
1. Purpose
a. Nutrition Indicators
 Risk factors for developing diverticulosis and eventually diverticulitis include
history of constipation, low fiber intake, high intake of red meat, obesity and
decreased physical activity.
b. Criteria to Assign the Diet
 Signs and symptoms for diverticulitis include fever, abdominal pain in the lower
left quadrant, GI bleeding and elevated white blood cell count. A CT scan can be
ordered in order to view the pouches and assess for inflammation.
c. Rationale for Diet
 For diverticulitis the patient will be NPO with bowel rest until the bleeding and
diarrhea stop. Oral intake will begin again with only clear liquids and oral
supplementation of vitamins and minerals. A low fiber diet will slowly begin and
once inflammation and bleeding is no longer a risk, a high fiber diet will be
prescribed.
2. Population
a. Overview
 Diverticulitis is mainly a concern in older people. Approximately 10% of
Americans over the age of 40 have diverticulosis. About 10 to 25% of those with
diverticulosis will develop diverticulitis. It has been hypothesized that a lower
fiber diet may increase the incidence of diverticular disease.
b. Disease Process
 Diverticulosis is the abnormal presence of out pockets or pouches (diverticula) on
the surface of the small intestine or colon. The diverticula occur when the inner
layer of the digestive trace protrudes through weak spots in the outer layer. Many
people are unaware that they have diverticulosis, and when the diverticula get
inflamed or infected the disease state turns into diverticulitis. Most patients can
recover without complications with proper treatment. However, diverticulitis can
lead to some serious conditions such as perforation, peritonitis, abscess, fistula, a
blockage or obstruction of the intestine, or bleeding of the intestine.
 One half of people with diverticulitis will relapse within seven years after the
condition is treated and in remission.
 Out of all the people admitted to the hospital for diverticulitis usually only 1015% need surgery.
c. Biochemical and Nutrient Needs
 The main way to prevent both diverticulosis and diverticulitis is to consume a
high fiber diet. Prebiotics and probiotics are also an important component to
recovery.
3. General Guidelines
a. Nutrition Rx
 A high fiber diet consists of 6 to 10 grams beyond the standard recommendation
for the patient. The fiber should be added gradually in order to ensure tolerance.
Prebiotic and probiotic food sources can also be added.
b. Adequacy of Nutrition Rx
 It is accepted by AND that a high-fiber nutrition therapy diet is recommended to
prevent diverticulosis, and prevent reoccurring diverticulitis post-episode.
c. Goals
 The patient will need to be able to identify foods that result in pain, diarrhea and
constipation and reduce the intake of those foods.
 The patient will need to identify an adequate fluid intake.
 The patient will need to identify food choices that are highest in fiber.
 The patient will need to be able to identify sources of probiotics.
d. Does it Meet DRI
 The diet calls for fiber that exceeds the DRI for the patient by 6 to 10 grams.
Supplementation may need to be utilized for those who cannot meet this
requirement with diet alone.
4. Education Material
a. Nutrition Therapy
 Provide nutrition education pamphlet on high fiber foods. The pamphlet will help
the client to learn how to make food choices that contain high fiber. The pamphlet
will also explain what probiotics are and how to incorporate them into the diet.
b. Ideas for Compliance
 Discuss with the client how to plan meals and snacks that include high fiber
foods.
 Discuss with the client that use of supplementation if necessary.
 Provide outside resources for further questions.
5. Sample Menu
a. Foods Recommended
 Once the acute episode is resolved, high fiber foods should be slowly introduced.
 Foods include: high fiber cereal with at least 4 g per serving, beans, whole grains,
raspberries, blackberries and prunes.
b. Foods to Avoid
 It has been a common practice to avoid nuts, seeds and hulls because there was a
theory that they would aggravate the condition or result in inflammation. They
only need to be avoided if this is a concern to the patient.
c. Example of a meal plan
 Breakfast: 1 cup fiber one cereal with ½ cup skim milk and ½ cup strawberries.
 Lunch: Turkey Sandwich on whole wheat bread with Swiss cheese, ½ cup carrots
and 1 oz of Sunchips.



Snack: 8oz of Activa yogurt and an apple with the skin.
Dinner: Stir fry with brown rice, chicken and mixed vegetables, ½ cup
blueberries, ½ cup skim milk.
Snack: 2 cups of popcorn
6. Websites
a. Organizations with Websites
 Colon and Rectal Disease Center
 Academy of Nutrition and Dietetics
 University of Maryland Medical Center
o http://www.umm.edu/altmed/articles/diverticular-disease-000051.htm
b. Government Websites
 http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001303/
7. References
a. Journal articles references
 http://www.mayoclinic.com/health/high-fiber-foods/NU00582
 http://www.diverticulitisdaily.com/